| Plan Name | Blue Advantage Bronze HMO 006 | Blue Advantage Plus Bronze 104 | Blue Advantage Silver HMO 103 |
|---|---|---|---|
| Plan Brochure | Plan Details | Plan Details | Plan Details |
|
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.
|
$6,500 | $5,000 | $3,750 |
|
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max
|
None (Member pays 0% after deductible) | 40% | 0% |
|
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services (includes deductible) |
$6,500 | $6,550 | $3,750 |
| Primary Care Office Visit | 0% after deductible | 40% | $30 |
| Specialist Office Visit | 0% after deductible | 40% | $0 after deductible |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 0% after deductible | 40% | 40% |
| Emergency Room | 0% after deductible | 40% | 40% |
| Urgent Care | 0% after deductible | $20 | $0 after deductible |
| Inpatient Hospital Service | 0% after deductible | 40% | $0 after deductible |
| Outpatient Surgery | 0% after deductible | 50% | $0 after deductible |
| Outpatient X-Rays and Diagnostic Imaging | 0% after deductible | 50% | $100 |
| Outpatient Imaging (CT/PET Scans/MRIs) | 0% after deductible | 50% | $0 after deductible |
| Network | Blue Advantage HMO | ||
| HSA Eligible | Yes | Yes | Yes |
| Outpatient Prescription Drugs – Preferred Pharmacy | 0% after deductible | 30%/30%/40%/50%/50% | $0 after deductible |
| Outpatient Prescription Drugs – Non-Preferred Pharmacy | 0% after deductible | 35%/35%/50%/50%/50% | $0 after deductible |
| Prescription Drug Utilization Benefit Management Programs | Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. | ||
When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.